Equine Therapy: Sound Choices

Keeping your horse in action or getting him sound and back into battle: twin goals of just about everyone who works with competition horses or who spends a chunk of time playing with their pleasure horses. Consequently, an entire industry of physical therapy devices has emerged, promising to help heal your horse's sore muscles, mend hard- or soft-tissue injuries, or soothe acute or chronic lameness conditions.

The best person to help you prevent and treat injuries in your athletic horse is your veterinarian. He or she might recommend a variety of approaches best suited to your horse, situation, and particular injury or discipline.

Below we will describe several of the modalities used by veterinarians or other professionals working under the guidance of a veterinarian, and we'll help you understand what they are "supposed" to do. Remember, just because a manufacturer advertises its product is capable of doing a particular thing, that doesn't mean there is scientific proof of that claim. Always seek the advice of your veterinarian.

Diagnosis First

Some physical therapy devices are useful to help reduce or control pain, control swelling or edema, and improve range of motion. Some top-level equine competitors that cannot have medications during or just before events will be treated with some of the modalities mentioned here as part of an overall care program designed by a veterinarian.

"There is a tremendous variety of physical therapy devices," notes Duncan Peters, DVM, MS, co-director of the Sport Horse Program at Hagyard Equine Medical Institute in Lexington, Ky. "Most of them have some type of benefit if used properly and used appropriately.

Caveat Emptor

It is important to remember that many available equine therapies have not been evaluated by controlled clinical trials or experiments. This means that veterinary researchers haven't verified whether these products are helpful and, more importantly, that they don't cause harm.

This is why we give you a word of caution when you and your veterinarian are sizing up therapeutic devices. Before making a decision to use any sort of therapy, you should consult your veterinarian for advice. Nat White, DVM, MS, Dipl. ACVS, director of the Marion duPont Scott Equine Medical Center in Leesburg, Va., and a member of The Horse's editorial advisory board, says, "Other than shock wave and cold therapy there is very little research or even clinical documentation that therapeutic systems provide a benefit for horses' injuries."

Even without solid scientific studies on these devices, we realize that the products are available and are in use. It would be turning a blind eye to not describe what is known about different types of equine therapy equipment. So here is what we know. Inclusion in this article does not imply endorsement. We ask you to talk with your veterinarian about any of these therapies before making a decision about their use, since most of the available information on them is anecdotal. We strongly encourage horse owners to pursue therapies that have been verified through "evidence-based medicine."

Keep in mind: As with any medical treatment or therapy that's been used over the years, consumers--both veterinarians and horse owners--will choose to use them as long as they believe there is anecdotal evidence that it might be helping the animal. And, as with any other therapy or treatment in veterinary medicine, scientists might eventually find through controlled studies that untested therapeutic techniques have no effect or impede health rather than help it.

--Stephanie L. Church

"Unfortunately, one of the biggest problems we run into with physical therapy devices are people indiscriminately using 'whatever' on their injured horses without knowing if the device is really appropriate for the particular disorder," he adds. "That's where these therapies go wrong or get a bad rap, by being used for conditions where they're not going to generate a response."

The key to appropriate use begins with getting an accurate diagnosis so you know what you're dealing with, says Peters, who is an FEI-licensed event veterinarian in reining, eventing, dressage, jumping, and driving. "Once you identify the problem, you can look for a suitable therapy for the condition being treated, whether that's medication, support, adjunctive therapies, or physical therapy."

A wide variety of devices is out there. These items range from the simple, inexpensive models to the pricey and high-tech. Professional models also are generally available only in veterinary specialty or physical therapy practices.

Cold Therapy

Cold therapy is useful for acute problems, particularly within the first 48 hours after injury, say proponents. It works by constricting the capillaries and slowing tissue responses, thus reducing swelling, inflammation, and pain transmission.

Among cold therapy devices, ice boots are a favorite recommendation of Kate Running, DVM, Certified Veterinary Acupuncturist (CVA), of Running R Veterinary Services in the Tolar/Fort Worth, Texas, area. "It's my pick for owners to use," says Running, a cutting horse competitor with dressage and Western competition clientele. "Ice boots are inexpensive, portable, effective, and something an owner can do at home. The owner can also use ice boots preventively after a workout to help reduce swelling, edema, inflammation, and mild discomfort that could come from a very rigorous training session.

Running cautions that ice boots should not be left on too long because tissue damage could occur, just as if you put your hand in ice for a prolonged period of time. "More is not better," she says. "You can, however, use cold therapy for 10 minutes, let the legs warm for 10 minutes, and cool again. Don't exceed recommended parameters."

A more sophisticated, albeit more expensive, cold therapy device favored by Running and Peters is Game Ready Equine's unit. This portable machine uses cold circulating water delivered via flexible wraps and hoses to provide dry and cold intermittent compression.

Peters, who is a member of the Game Ready advisory board, explains that the cold compression and the alternation of compression/release of compression might help circulation in the affected limb return to normal. "Game Ready and other units that employ similar principles are beneficial for treating bruises, contusions, and swelling--acute rather than chronic injuries," he says.

Although a complete kit costs about $3,200, many veterinarians rent their units to clients.

Oxygen and Shock Wave Therapies

Hyperbaric oxygen therapy (HBOT)is a modality whereby the horse is walked into a trailerlike airtight pressure chamber and receives oxygen at approximately two to three times the normal atmospheric pressure. Treatment sessions last about 45 to 120 minutes. The increased oxygen enters the bloodstream and increases the oxygen concentration in the tissues.

"HBOT is used to assist healing and to speed recovery of poor-healing wounds, certain aerobic and anaerobic infections, bone (osteomyelitis), and necrotizing soft-tissue infections," according to an article in DVM Newsmagazine ("Equine Facilities Claim Positive Results With Hyperbaric Oxygen Therapy," by Ed Kane, July 1, 2007). "It is also reportedly showing some benefit in patients (foals) with hypoxic-ischemic encephalopathy, tendinous and ligamentous injuries (in athletic horses), respiratory conditions, as well as intestinal ischemic injury like colon torsion and small-intestinal strangulation." However, this technology is new to equine medicine and there is minimal research to help guide its use in horses. Numerous studies in laboratory animals and clinical experience in human medicine suggest both advantages and disadvantages for this treatment modality.

Only about a dozen equine veterinary facilities in the United States offer HBOT, with private facilities charging about $300 to $400 per session. Depending upon the disorder and severity of the condition being treated, a horse could require anywhere from two to 30 treatments, depending on their response to treatment.

"Shock wave therapy has been pretty useful for injuries in areas where there are attachments of ligament to bone, like the high suspensory ligament or a collateral ligament," states Peters.

Treatment of those types of injuries involves significant time off and limited exercise. "But every so often those affected areas need to be stressed," he explains. Shock wave is applied directly to the injured tissue at those attachments between the bone and the ligament," and it appears to enhance healing and reduce pain in the area.

Shock wave therapy is performed by professionals at veterinary hospitals and clinics on an outpatient basis on standing, sedated horses. Depending upon where ESWT is performed, each treatment (per site) could cost about $150 to $200 or more. Recommendations vary, but from three to six treatment sessions are recommended with an interval of seven to 30 days between sessions. The response to shock wave can vary with some injuries refractory to this treatment, even with multiple treatments. The response should be evaluated using ultrasound to make sure healing has progressed sufficiently before exercise is increased during rehabilitation.

Other Therapies

Following are some other modalities that some therapists and veterinarians feel are of potential benefit, but current scientific research in horses is not yet available. Regardless, some practitioners use them and believe in their effectiveness in specific situations.

Therapeutic ultrasound is a form of sound energy used for treating acute and chronic musculoskeletal injuries, decreasing stiffness and pain, and reducing swelling. "Ultrasound has use in some of the heavier muscle areas like down through the back, with muscle strains and pulls, and down through the gluteal muscles and hindquarters." Peters says.

Running notes, "There are units that clinics rent to owners for use at home." However, it's very important that veterinarians and owners follow the directions for application so as not to exceed the time or dose of sound waves. Excessive application can cause burns and tissue injury if not used appropriately.

Electrical stimulation is sometimes referred to as electrical nerve stimulation (ENS), transcutaneous electrical nerve stimulation (TENS), galvanic stimulation (a misnomer), or, erroneously, electrical muscle stimulation (EMS). Electrical stimulation devices cause the muscle to contract through motor nerve stimulation via a mild electric current delivered by skin surface electrodes. This action might stimulate local circulation and metabolism, and this helps reduce swelling at the site of the injury. The benefit of TENS treatment has yet to be scientifically documented in horses, and its use should be completed carefully, as an excessive dose can be painful.

An additional benefit proposed by advocates of this procedure is the apparent production of serotonin, endorphin, and other relaxing neurotransmitters, but this remains unproven in the horse.

Owners can operate these units themselves on their horses, but they should do so only under the direction of their veterinarians to ensure proper settings and electrode placement.

Laser therapy involves using an intense beam of light in an attempt to decrease repair time, relieve swelling, promote healing of surface wounds, achieve pain relief, and stimulate blood flow, say advocates of the modality, although none of these effects have ever been proven to occur in horses. Lasers are used by practitioners both in the field and at the clinic for treating tendon and ligament injuries, joint and bone injuries, open and post-surgical wounds and ulcers, osteoarthritis, and other conditions. The lasers available for transcutaneous treatment have limited power and their ability to penetrate to damaged tissue has yet to be proven with scientific investigations or clinical studies.

Electromagnetic field units are used in an attempt to improve lower leg bone problems, such as bone bruises and splints, says Peters. It's thought that pulse or static magnetic fields stimulate cells that assist in the healing process; the pulsed electromagnetic fields are applied to the body by means of multiple flat coils, located inside therapy blankets or leg wraps, and they are powered by batteries or power units.

The units have their critics, mainly because at least one scientific study concluded that low-intensity static magnetic fields have no effect on blood circulation to the skin overlying the third metacarpal (cannon bone) region. The investigators in that study concluded that even if there were an increase, it might not equate to a beneficial physiologic effect.

"They are another easy therapy for horse owners," Peters says, but they are expensive, with boots costing several hundred dollars and blankets costing a few thousand dollars.

Pulsed signal therapy differs from pulsed electromagnetic field therapy in that PST uses electrical signals akin to the body's intrinsic signals delivered to the injury site by a magnetic wave pulse to achieve healing. This compares to pulsed magnetic therapy, in which the pulsed magnetic field itself is thought to stimulate healing. The mobile PST unit consists of two pads that are placed over the treatment area, receiving power through a magnetic field signal power unit.

The therapy has been available for small animals in the United States for a number of years; PST for horses was introduced in the United States in 2008. (It has been approved for use in animals and humans in Canada, Europe, Asia, and South America.) Portable equine units can be used by the practitioner at the farm or clinic (sales are restricted to equine health professionals).

Since reliable published studies in horses are lacking, the jury is still out on whether there is credible scientific evidence that this therapy is useful.

Massage is claimed to promote circulation, alleviate muscle soreness, and relax the horse. This type of therapy is employed for acute and chronic injuries, as well as being used preventively before or after exercise to help prevent injury.

Massage equipment ranges from small, inexpensive, handheld models to costlier heavier-duty "large animal" units that require two-handed operation. "Owners can purchase small massagers to use on small, localized areas," says Running. "These units are easy to take with you if you go on the road."

The big units are more appropriate for deep muscle massages, but you have to be careful to avoid going over less-muscled areas such as hocks, stifles, and the back. "Large massagers can be painful in areas where there is little padding from muscle tissue," Running warns. "You could press skin on bone or pinch nerves. I recommend that owners use any massagers on themselves so they can see if it could be uncomfortable to their horse."

Final Thoughts

Peters cautions that no device will dramatically speed up recovery time. "Used appropriately, they may help the body do a better job of healing itself and in repairing the damage process," he says, adding that, in general, we need to give these problems adequate time to heal.